This thoughtful essay conveys a logically ordered series of concepts that may help develop a process to more fully integra te evidence into healthcare management decisions. In responding to this article we have tried to think bro adly about what might be discovered if t he ideas of Browman, Snider and Ellis were put into practice. We have chosen to focus on factors that could confound the five-point plan suggested by the authors. Browman, Snider and Ellis provide an interesting overview and advocacy for evidence - based medicine and its application. The authors recognize that the area under investigation, oncology, may lend itself more readily than others to the facilitation of evidence - based practice. They introduce the concept of healthcare as a negotiating environment and the healthcare manager as a potential catalyst for change. In their conclusions the authors offer healthcare managers a five-point plan:

1. Express the value that knowledge is a core resource.
   
2. Structure decision-making to involve the stewards of knowledge and stimulate negotiation while encouraging the parties to express shared goals.
   
3. Invest in strategies that support knowledge management, including arbitration.
   
4. Demonstrate leadership and develop organizational metaphors to encourage participation.
   
5. Share the results and experiences of evidence-based decision-making.

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